Articulating ultrasonic surgical instrument

ABSTRACT

A therapeutic ultrasound instrument is described for cutting, dissecting, or cauterizing tissue. Ultrasonic vibrations, when transmitted to organic tissue at suitable energy levels and using a suitable end-effector, may be used for the safe and effective treatment of many medical conditions. An ultrasonic surgical instrument is described which incorporates an articulating end-effector. The instrument comprises an ultrasonic signal generator, an ultrasonically actuated end-effector, and a substantially solid ultrasonic waveguide which connects the ultrasonic signal generator to the end-effector. The waveguide comprises a transmission section extending from the signal generator to a fixed node, and an articulation section extending from the fixed node to an pivoting node. The end-effector includes a waveguide segment. A handle is adapted to hold the signal generator. An outer sheath extends from the handle to the end-effector and surrounds the waveguide. An actuation trigger is rotatably positioned on the handle, and an actuation arm extends from a distal end of the actuation trigger to the pivoting node. The actuation arm is connected to the pivoting node by a lever arm which extends from the pivoting node. Such instruments are particularly suited for use in minimally invasive procedures, such as endoscopic or laparoscopic procedures.

This application is a continuation of U.S. patent application No.09/059,072 which as filed Apr. 13, 1998.

FIELD OF THE INVENTION

The present invention relates, in general, to an ultrasonic surgicalinstrument and, more particularly, to an ultrasonic surgical instrumentincorporating an articulating end-effector.

BACKGROUND OF THE INVENTION

Ultrasonic instruments, including both hollow core and solid coreinstruments, are used for the safe and effective treatment of manymedical conditions. Ultrasonic instruments, and particularly solid coreultrasonic instruments, are advantageous because they may be used to cutand/or coagulate organic tissue using energy in the form of mechanicalvibrations transmitted to a surgical end-effector at ultrasonicfrequencies. Ultrasonic vibrations, when transmitted to organic tissueat suitable energy levels and using a suitable end-effector, may be usedto cut, dissect, or cauterize tissue. Ultrasonic instruments utilizingsolid core technology are particularly advantageous because of theamount of ultrasonic energy which may be transmitted from the ultrasonictransducer through the waveguide to the surgical end-effector. Suchinstruments are particularly suited for use in minimally invasiveprocedures, such as endoscopic or laparoscopic procedures, wherein theend-effector is passed through a trocar to reach the surgical site.

Solid core ultrasonic instruments adapted for use in surgery and, moreparticularly, for use in minimally invasive surgery, are well known inthe art. For example, U.S. Pat. No. 5,322,055 illustrates a clampcoagulator which utilizes solid core ultrasonic technology while U.S.Pat. No. 5,324,299 illustrates an ultrasonic hook blade end-effector foruse in surgical applications. In addition, articulating instruments foruse in minimally invasive surgery are also known in the art. Forexample, U.S. Pat. No. 5,409,498 describes an articulating endocutterfor use in cutting and stapling tissue. Many ultrasonic surgicalinstruments used for cutting and coagulation rely upon relatively stiff,solid core ultrasonic waveguides to efficiently deliver energy from thetransducer to the end-effector. In such instruments it may be desirableto articulate the end-effector in order to provide the surgeon withflexibility in engaging hard to reach structures. However, therelatively stiff solid core ultrasonic waveguides and the limitedstructural space available in minimally invasive instruments make itdifficult to design appropriate mechanisms for articulatingend-effectors in such devices. One option, which is illustrated anddescribed in U.S. patent application Ser. No. 08/770,550 [AttorneyDocket No. END-340] which was previously incorporated herein byreference, involves separating the waveguide into two or more segmentswhich may be moved independently to provide articulation.

Flexible high power ultrasonic surgical instruments are also available.Flexible ultrasonic surgical instruments such as atherosclerosistreatment devices, thrombolysis devices, or some stone crushing devicesare typically thin wires encased in a polymeric sheath, are relativelyflexible, and articulate if assisted with known flexible endoscopyarticulation means. For example, U.S. Pat. No. 5,380,274 describes aflexible ultrasonic catheter, and U.S. Pat. No. 4,108,211 describes aflexible endoscope mechanism.

It would, therefore, be advantageous to design an articulating solidcore ultrasonic surgical instrument wherein the ultrasonic waveguide issubstantially continuous. It would further be advantageous to design asolid core ultrasonic surgical instrument wherein the end-effector wasboth rotatable and articulatable. It would further be advantageous todesign an articulating solid core ultrasonic surgical instrument whichcould be passed through a trocar or other surgical access device and theend-effector could be articulated utilizing a handle positioned outsideof the surgical access device.

SUMMARY OF THE INVENTION

A surgical instrument comprising an ultrasonic signal generator, anultrasonically actuated end-effector, and a substantially solidultrasonic waveguide which connects the ultrasonic signal generator tothe end-effector. The waveguide comprises a transmission sectionextending from the signal generator to a fixed node, and an articulationsection extending from the fixed node to an pivoting node. Theend-effector includes a waveguide segment. A handle is adapted to holdthe signal generator. An outer sheath extends from the handle to theend-effector and surrounds the waveguide. An actuation trigger isrotatably positioned on the handle, and an actuation arm extends from adistal end of the actuation trigger to the pivoting node wherein theactuation arm is connected to the pivoting node by a lever arm whichextends from the pivoting node.

BRIEF DESCRIPTION OF THE DRAWINGS

The novel features of the invention are set forth with particularity inthe appended claims. The invention itself, however, both as toorganization and methods of operation, together with further objects andadvantages thereof, may best be understood by reference to the followingdescription, taken in conjunction with the accompanying drawings inwhich:

FIG. 1 is a perspective view illustrating a surgical instrumentincluding an articulatable end-effector according to the presentinvention, wherein the surgical instrument is illustrated in combinationwith and ultrasonic signal generator.

FIG. 2 is an exploded perspective view of a surgical instrumentaccording to the present invention.

FIG. 3 is a perspective view of the articulation collar of thearticulation actuation mechanism shown in FIG. 4.

FIG. 4 is a perspective view of an actuation mechanism internal to thesurgical instrument shown in FIG. 1.

FIG. 5 is a side sectional view illustrating the distal end of theultrasonic transmission rod assembly of a surgical instrument accordingto the present invention.

FIG. 6 is a cutaway perspective view illustrating a distal portion ofthe ultrasonic transmission rod assembly of a surgical instrumentaccording to the present invention.

FIG. 7 is a perspective view illustrating a distal portion of theultrasonic transmission rod assembly of a surgical instrument accordingto the present invention wherein the articulated position of theend-effector is shown in phantom.

FIG. 8 is a side sectional view illustrating the distal end of theultrasonic transmission rod assembly of a surgical instrument accordingto the present invention with the end-effector in the articulatedposition.

FIG. 9 is a cutaway perspective view illustrating a distal portion ofthe ultrasonic transmission rod of a surgical instrument according tothe present invention with the end-effector in the articulated position.

DETAILED DESCRIPTION OF THE INVENTION

FIG. 1 is a perspective view illustrating a surgical instrument 10including an end-effector 18 which may be articulated according to thepresent invention. In FIG. 1, surgical instrument 10 is illustrated incombination with ultrasonic signal generator 12. Ultrasonic surgicalinstrument 10 includes instrument handle 14, ultrasonic transmission rodassembly 16 and ultrasonic effector 18. Ultrasonic signal generator 12includes generator housing 17 and power supply cable 20. Ultrasonicsurgical generator 12, which may also be referred to as a handpiece,comprises a housing 17, housing a transducer, preferably a piezeoceramictransducer, for converting an electrical signal, for example, a 55,000Hz sinusoidal waveform, into a mechanical longitudinal vibration. Asuitable ultrasonic signal generator is available from EthiconEndo-Surgery, Inc. as make ULTRACISION® and model HP051. Instrumenthandle 14 includes finger grip 22, actuation trigger 24 and rotationknob 26. Ultrasonic transmission rod assembly 16 includes outer sheath28, ultrasonic waveguide 30, mounting arm 32, actuating arm 34 and pivotslot 36. End-effector 18 includes hook blade 38 and waveguide segment40.

FIG. 2 is an exploded perspective view of surgical instrument 10. FIG. 2illustrates the elements and interconnection of instrument handle 14,ultrasonic transmission rod assembly 16 and ultrasonic end-effector 18.Instrument handle 14 includes left housing half 42 and right housinghalf 44. Left housing half 42 includes finger grip 22. Actuation trigger24 is rotatably mounted on pivot pin 46 between left housing half 42 andright housing half 44. Actuation trigger 24 includes thumb ring 48,pivot 50, yoke 52, yoke arms 54 and detent pins 56. Articulation collar58 is positioned in yoke 52 and rotatably engaged by detent pins 56.Rotation knob 26 is rotatably positioned between left housing half 42and right housing half 44 at the distal end of instrument handle 14.Rotation knob 26 includes rotation disk 60, rotation channel 62,rotation drive tube 64 and rotation knob connector pin holes 66. Theproximal end of ultrasonic transmission rod assembly 16 is connected torotation knob 26 by rotation connector pin 68.

In FIG. 2 ultrasonic transmission rod assembly 16 includes outer sheath28, ultrasonic waveguide 30, mounting arm 32 and actuating arm 34. Outersheath 28 is affixed to ultrasonic waveguide 30, mounting arm 32,actuating arm 34 and rotation drive tube 64 by rotation connector pin 68which passes through rotation knob connector pin holes 66, waveguideconnector pin hole 70, outer sheath connector pin holes 67, waveguideconnector pin hole 70, mounting arm connector pin hole 72, and actuationarm connector pin slot 74. Outer sheath 28 includes proximal tube 76,wrench flats 78 and waveguide support tube 80. Waveguide support tube 80includes one or more pivot slots 36 which are positioned at a distal endof waveguide support tube 80. Mounting arm 32 and actuating arm 34 arepositioned within and extend from the proximal to the distal end ofouter sheath 28. Actuating arm 34 includes actuation arm connector pinslot 74 and actuation slot 82 at the proximal end thereof and distalslot 84 at a distal end thereof. Actuation arm 34 is adapted to engagearticulation collar 58. Mounting arm 32 and actuating arm 34 arepositioned on either side of ultrasonic waveguide 30 within outer sheath28.

In FIG. 2 ultrasonic waveguide 30 includes node isolator 88, connectorsegment 86, transmission segment 90 and articulation segment 92.Articulation segment 92 is bounded by fixed node 91 at the proximal endthereof and pivoting node 93 at the distal end thereof. Waveguidesegment 40 of ultrasonic end-effector 18 is connected to ultrasonicwaveguide 30 at pivoting node 93. The distal end of waveguide segment 40is connected to hook blade 38. Articulation segment 92 is generallythinner than transmission segment 90 and, more particularly, preferablyhas a diameter of 20 to 70 percent of the diameter of the narrowestportion of transmission segment 90. In addition, or as an alternative,articulation segment 92 may include a bend or curve to facilitaterotational movement of pivoting node 93. Rotation is facilitated byreducing the force required to bend articulation segment 92. Ultrasonicwaveguide 30 is preferably fabricated from a solid core shaftconstructed out of material which propagates ultrasonic energyefficiently, such as a titanium alloy (e.g., Ti-6A1-4V) or an aluminumalloy.

FIG. 3 is a detailed perspective view of articulation collar 58. Asillustrated in FIG. 3, articulation collar 58 includes collar rotationchannel 57, collar latch 59, collar central aperture 61 and collar guideflanges 63.

FIG. 4 is a detailed perspective view of handle actuation mechanism 51of surgical instrument 10. In handle actuation mechanism 51, actuationtrigger 24 is pivotally connected to articulation collar 58 by yoke 52.Yoke arms 54 of yoke 52 spring load detent pins 56 in collar rotationchannel 57. The proximal end of ultrasonic waveguide 30 extends throughcentral aperture 61 of articulation collar 58. The proximal end ofactuating arm 34 extends into collar central aperture 61 of articulationcollar 58. Collar latch 59 of articulation collar 58 engages actuationslot 82 which is positioned at the proximal end of actuating arm 34.Collar guide flanges 63 of articulation collar 58 support and align theproximal end of ultrasound transmission rod assembly 16. The proximalends of ultrasonic waveguide 30 and mounting arm 32 are rotationally andaxially affixed to rotation knob 26 by rotation connector pin 68 whichpasses through rotation drive tube 64. The proximal end of actuating arm34 is rotationally affixed to rotation knob 26 by rotation connector pin68 which passes through rotation drive tube 64 and actuation armconnector pin slot 74 of actuating arm 34.

FIG. 5 is a side sectional view illustrating the distal end ofultrasonic transmission rod assembly 16 and end-effector 18 of surgicalinstrument 10. In FIG. 5, fixed node 91 includes mounting flanges 94which are positioned in isolation mounts 95. Isolation mounts 95 arepositioned between and held in place by rigid flanges 31 on the interiorof outer sheath 28 and rigid flanges 33 on mounting arm 32. Distal slot84 in actuation arm 34 is positioned such that mounting flange 94 passesthrough distal slot 84 to isolation mount 95. Pivoting node 93 includesmounting flanges 96 which are positioned in isolation mounts 97.Mounting flanges 96 may be referred to, either alone or in combination,as a rotational flange. Isolation mounts 97 are positioned between andheld in place by rigid flanges 35 on mounting arm 32 and rigid flanges37 on actuating arm 34. Isolation mounts 95 and 97 are typicallyconstructed of an elastomeric material, such as silicone rubber.

FIG. 6 is a cutaway perspective view illustrating a distal portion ofultrasonic transmission rod assembly 16 and end-effector 18 of surgicalinstrument 10. In FIG. 6, articulation pivot pin 39 passes through pivotslot 36 and pivot hole 41 which passes through ultrasonic waveguide 30at pivoting node 93.

The operation of a surgical instrument according to the presentinvention may now be described in detail. FIG. 7 is a perspective viewillustrating a distal portion of ultrasonic transmission rod assembly 16of surgical instrument 10 according to the present invention wherein thearticulated position of end-effector 18 is shown in phantom. FIG. 8 is aside sectional view illustrating the distal end of the ultrasonictransmission rod assembly 16 and end-effector 18 of surgical instrument10 according to the present invention with end-effector 18 in itsarticulated position. FIG. 9 is a cutaway perspective view illustratinga distal portion of ultrasonic transmission rod assembly 16 of surgicalinstrument 10 according to the present invention with end-effector 18 inits articulated position.

In operation, end-effector 18 may be articulated by moving actuationtrigger 24 of instrument handle 14 toward finger grip 22. When actuationtrigger 24 is moved toward finger grip 22, pivot 50 of actuation trigger24 pivots on pivot pin 46, forcing yoke 52 to move toward the proximalend of instrument handle 14. Proximal movement of yoke 52 is transmittedto articulation collar 58 by yoke arms 54 and detent pins 56 whichengage articulation collar 58 in collar rotation channel 57. Thus whenactuation trigger 24 is moved toward finger grip 22, articulation collar58 is moved axially in a distal to proximal direction.

Axial movement of articulation collar 58 is transmitted to actuating arm34 by collar latch 59 which engages actuation slot 82 in actuating arm34. Actuation arm connector pin slot 74 in actuating arm 34 is elongatedto ensure that rotation connector pin 68 and node isolator 88 do notinterfere with the axial movement of actuating arm 34. Similarly, distalslot 84 in actuating arm 34 is elongated to ensure that rigid flanges31, mounting flange 94 and isolation mount 95 do not interfere with theaxial movement of actuating arm 34. Thus, distal to proximal axialmovement of articulation collar 58 forces actuating arm 34 to moveaxially in a distal to proximal direction and, since articulation collar58 is free to move axially with respect to the proximal end ofultrasonic waveguide 30, axial movement of actuating arm 34 does notresult in axial movement of the proximal nd of ultrasonic waveguide 30.

Articulation is accomplished by the relative axial movement of theproximal end of actuating arm 34 with respect to the proximal end ofultrasonic waveguide 30 while the distal end of actuating arm 34 isfixed to at least one side of the distal end of ultrasonic waveguide 30at the distal end of articulation segment 92. Mounting flanges 94 arerigidly affixed to ultrasonic waveguide 30 at fixed node 91, which ispositioned at the proximal end of articulation segment 92 while mountingflanges 96 are rigidly affixed to ultrasonic waveguide 30 at pivotingnode 93, which is positioned at the distal end of articulation segment92. Fixed node 91 is held in place by mounting flanges 94 which arepositioned in isolation mounts 95. Isolation mounts 95 are held in placeby rigid flanges 31 on mounting arm 32 and by rigid flanges 33 on outersheath 28. Pivoting node 93 is pivoted around articulation pivot pin 39by the rotational force exerted on mounting flanges 96 when actuatingarm 34 is moved axially in a distal to proximal direction. Mountingflanges 96 are positioned in isolation mounts 97 which are held in placeby rigid flanges 35 on mounting arm 32 and by rigid flanges 37 onactuating arm 34. Thus, distal to proximal axial movement of actuatingarm 34 moves rigid flanges 37 and isolation mount 97 in a distal toproximal direction, applying a force to one mounting flanges 96.However, since the opposite one of mounting flanges 96 is held fixed bymounting arm 32, the force applied to pivoting node 93 is substantiallyrotational. Thus, with fixed node 91 held firmly in place and arotational force applied to pivoting node 93, the force applied toarticulation segment 92 by the axial movement of actuating arm 34 willtend to force articulation segment 92 to flex away from actuating arm34, allowing pivoting node 93 to pivot around articulation pivot pin 39and end-effector 18 to articulate as illustrated in FIGS. 7, 8 and 9.

In order to properly position end-effector 18 prior to or after it isarticulated, surgical instrument 10 is also adapted to allowend-effector 18 to be rotated around a central axis. Axial rotation ofend-effector 18 is accomplished by moving rotation knob 26. Whenrotation disk 60 of rotation knob 26 is rotated, rotational force istransmitted through rotation drive tube 64 to rotation connector pin 68.As illustrated in FIG. 2, rotation channel 62 is mounted between lefthousing half 42 and right housing half 44 such that rotation knob 26 maybe freely rotated but will not move axially with respect to instrumenthandle 14. Rotation connector pin 68 passes through rotation knobconnector pin holes 66, outer sheath connector pin holes 67, mountingarm connector pin hole 72, waveguide connector pin hole 70 and actuationarm connector pin slot 74, thus transmitting rotational forces fromrotation knob 26 to outer sheath 28, mounting arm 32, ultrasonicwaveguide 30 and actuating arm 34. Rotational forces are, in turntransmitted back to articulation collar 58 by the interconnection ofactuation slot 82 and collar latch 59. Rotational forces are transmittedto end-effector 18 by ultrasonic waveguide 30 which is rigidly affixedto waveguide segment 40 at pivoting node 93. Collar rotation channel 57may be adapted to include detents (not shown) which, in conjunction withdetent pins 56 may be used to rotationally position end-effector 18 andto prevent inadvertent rotational movement of end-effector 18.

While preferred embodiments of the present invention have been shown anddescribed herein, it will be obvious to those skilled in the art thatsuch embodiments are provided by way of example only. Numerousvariations, changes, and substitutions will now occur to those skilledin the art without departing from the invention. Accordingly, it isintended that the invention be limited only by the spirit and scope ofthe appended claims.

What is claimed is:
 1. An ultrasonic surgical instrument comprising:ahandle; a surgical end-effector; an ultrasonic transmission wireassembly operatively coupled between said handle and said surgicalend-effector, wherein said transmission wire assembly comprises:aproximal and a distal end, wherein said proximal end of said ultrasonictransmission wire assembly is coupled to said distal end of saidultrasonic transmission wire assembly and said distal end of saidultrasonic transmission wire assembly is coupled to said surgicalend-effector; and an actuating element extending from said handle tosaid distal end of said transmission wire assembly, wherein saidactuating element is operatively connected to said end-effector and tosaid handle, and wherein said ultrasonic transmission wire assembly isfixed at a said proximal end and rotatable at said distal end.
 2. Anultrasonic surgical instrument comprising:a handle; a surgicalend-effector; an ultrasonic transmission wire assembly operativelycoupled between said handle and said surgical end-effector, wherein saidtransmission wire assembly comprises:a proximal and a distal end,wherein said proximal end of said ultrasonic transmission wire assemblyis coupled to said distal end of said ultrasonic transmission wireassembly and said distal end of said ultrasonic transmission wireassembly is coupled to said surgical end-effector; and an actuatingelement extending from said handle to said distal end of saidtransmission wire assembly, wherein said actuating element isoperatively connected to said end-effector and to said handle; an outersheath having a proximal end and a distal end and surrounding saidultrasonic transmission wire assembly, said outer sheath terminatingproximal to said end-effector, wherein said outer sheath extends fromsaid handle to said distal end of said ultrasonic transmission wireassembly; a mounting flange positioned at said proximal end of saidultrasonic transmission wire assembly, said mounting flange being fixedto an interior surface of said outer sheath; and a rotation flangepositioned at said distal end of said ultrasonic transmission wireassembly wherein said rotation flange is attached to said ultrasonictransmission wire assembly and said actuating element.
 3. An ultrasonicsurgical instrument according to claim 2 wherein said ultrasonictransmission wire assembly is fixed at a said proximal end and rotatableat said distal end.
 4. An ultrasonic surgical instrument comprising:ahandle; a surgical end-effector; an ultrasonic transmission wireassembly operatively coupled between said handle and said surgicalend-effector, wherein said ultrasonic transmission wire assemblycomprises:an articulating ultrasonic waveguide segment having a proximalend and a distal end, wherein said proximal end of said articulatingultrasonic waveguide segment is coupled to said distal end of saidultrasonic transmission wire assembly and said distal end of saidarticulating ultrasonic waveguide segment is coupled to said surgicalend-effector; and an actuating element extending from said handle tosaid distal end of said ultrasonic transmission wire assembly, whereinsaid actuating element is operatively connected to said articulatingultrasonic waveguide segment and to said handle; an outer sheath havinga proximal end and a distal end and surrounding said ultrasonictransmission wire assembly and said actuating element, wherein saidouter sheath extends from said handle to said distal end of saidultrasonic transmission wire assembly; and a rotation flange positionedat said distal end of said ultrasonic transmission wire assembly whereinsaid rotation flange is attached to said ultrasonic transmission wireassembly and said actuating element.
 5. An ultrasonic surgicalinstrument according to claim 4 wherein said ultrasonic transmissionwire assembly is fixed at said proximal end and rotatable at said distalend.